=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245550748
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA R MOREAU-O'DONNELL PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2010
-----------------------------------------------------
Last Update Date | 01/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9302 N MERIDIAN ST STE 337
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46260-1843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-981-2971
-----------------------------------------------------
Fax | 317-593-5678
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9302 N MERIDIAN ST STE 337
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46260-1843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-981-2971
-----------------------------------------------------
Fax | 317-593-5678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Psychologist
-----------------------------------------------------
License Number | 20042428A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 20042428A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------